Identifying maternal mental health problems

Maternal mental health issues affect approximately 15% of all women who are pregnant or giving birth. There are a variety of terms that are used to label mental health issues during pregnancy or the postpartum period. Perinatal Mood Disorders, Postpartum Depression, Maternal Mental Health are common among them.  In a nutshell, these terms refer to a clinically significant experience of depression, anxiety or other mental health symptoms that last at least two weeks and are disruptive to normal functioning.  These symptoms may emerge in pregnancy or the postpartum period, even up to a year after the baby’s birth.   Many women are afraid, embarrassed, even ashamed to talk about what they are experiencing since it does not fit with the popular (but wrong) idea that women “should” be happy with pregnancy and the arrival of the new baby.

Postpartum Psychosis is a serious mental health condition which can emerge in the first few days postpartum. Symptoms of psychosis can include paranoia, disorganized thinking, delusions and beliefs that are irrational. These psychotic symptoms can emerge quickly and require immediate medical attention as they are at greatest risk for hurting themselves or the baby. 

The Baby Blues is very common in the first two weeks postpartum.  The Baby Blues are different from Postpartum Mood Disorders in that they are milder symptoms that typically resolve on their own.   The majority of women experience mild symptoms of sadness or anxiety, irritability, or sleep disruptions in the first few weeks after delivering. Good support from friends and family can be very helpful during this time.  Advice to support pregnant and postpartum moms

Identifying and treating maternal mental health issues are now recommended by the American College of Obstetrics and Gynecology.  Their 2015 committee opinion recommended the following to the OB/GYN community:

1) screen at least once during the perinatal period for anxiety and depression using a standardized, validated tool,

2) closely  monitor, evaluate and assess women with current depression and anxiety, a history of depression, anxiety or perinatal mood disorders or other risk factors,

3) screening must be accompanied with appropriate follow up and treatment to improve clinical outcomes, including medical and behavior health therapy when indicated, and

4) follow up systems need to be in place to ensure follow up for diagnosis and treatment.

This recommendation has undoubtedly increased the practice of obstetric providers screening for depression or anxiety during either pregnancy and the postpartum period.  Medical providers screen for depression and anxiety using standardized, validated tools, like the Edinburgh Postnatal Depression Screening (EPDS) or the PHQ-9.  Free and anonymous screenings are also available on line

Screening alone is not enough.  When a woman scores in a “high” range for a mental health issue, further evaluation is needed to determine treatment recommendations.  The provider may recommend counseling, medication, and/or other types of community- based support (like Healthy Families or Healthy Start).   Women may feel conflicted about treatment, especially if medication is discussed as an option.   Treating mental health issues during pregnancy

We know that depression and anxiety can be effectively treated during pregnancy and the postpartum period. Getting help is good for the mother and the baby.

Picture of Lisa B Kelly, LCSW

Lisa B Kelly, LCSW

Clinical Social Work/Therapist, LCSW, MPH